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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 30 Chapter 24 Long Term Care

24.7.7 EXAMPLES Single Individual with OLE, Categorically Needy Example: Mr. Maple, a full coverage Medicaid client, enters a nursing facility and wants Medicaid to pay toward his cost of care. He has $3,000 month unearned income. He is a single individual with OLE. Medicaid eligibility is already established. Even though his income exceeds 300% of the SSI payment level, he is eligible without a spenddown as a Categorically Needy Medicaid client. Therefore, only post-eligibility calculations must be performed. Post-eligibility calculations are as follows: $3,000 Client's gross monthly countable income -$50 Personal Needs Allowance $2,950 Remainder -$175 OLE $2,775 Client's resource amount which is also his total contribution toward his cost of care. Single Individual with OLE, Medically Needy Example: Same situation as above except the client is not a full coverage Medicaid client. His Medicaid eligibility must be established as SSI-Related/Monthly Spenddown. Eligibility calculations are as follows: $3,000 Income -$20 SSI Income Disregard $2,980 Remainder -$200 MNIL for One Person $2,780 Monthly Spenddown The monthly Medicaid cost for his care in the facility is $4,383. Therefore, his spenddown is met for the month and post-eligibility calculations are performed for any additional contribution he must make. Post-Eligibility calculations are as follows: $3,000 Income -$50 Personal Needs Allowance